PREDICTORS OF SEVERE COMMUNITY-ACQUIRED PNEUMONIA AMONG CHILDREN ADMITTED TO MOSUL GENERAL HOSPITAL

Abstract

Background: Community-acquired pneumonia (CAP) remains an important cause of morbidity and hospitalization among children, particularly in low- and middle-income countries. Early recognition of severe disease is essential to facilitate timely oxygen therapy, close monitoring, and appropriate escalation of treatment. Clinical findings and routinely available laboratory biomarkers may assist in identifying children at increased risk of severe CAP. Objectives: To identify the clinical and laboratory predictors of severe community-acquired pneumonia among children admitted to Mosul General Hospital. Patients and methods: A hospital-based cross-sectional analytical study was conducted at Mosul General Hospital, Nineveh Directorate of Health, Iraq, from January 2025 to July 2026. The study included 91 children admitted with community-acquired pneumonia. Demographic characteristics, clinical findings, laboratory parameters, and hospital outcomes were recorded. Clinical variables included respiratory rate, respiratory distress, chest indrawing, oxygen saturation, and oxygen requirement. Laboratory investigations included complete blood count, C-reactive protein (CRP), and procalcitonin. Patients were classified into severe and non-severe pneumonia groups according to predefined clinical criteria. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 31.0. Appropriate comparative tests, binary logistic regression, and receiver operating characteristic (ROC) curve analysis were performed. A P-value <0.05 was considered statistically significant. Results: Of the 91 children, 53 (58.2%) had non-severe pneumonia and 38 (41.8%) had severe pneumonia. The mean age was 3.8 ± 2.9 years, and males constituted 56.0% of the study population. Children younger than one year were significantly more frequent among severe cases than non-severe cases (23.7% vs. 11.3%, P=0.041). Tachypnea, respiratory distress, chest indrawing, nasal flaring, grunting, hypoxemia, and oxygen requirement were significantly more frequent among children with severe pneumonia (P<0.05 for all). Mean WBC and neutrophil counts were significantly higher in severe cases (17.2 ± 6.8 vs. 13.8 ± 5.1 ×10⁹/L, P=0.008; and 11.6 ± 5.8 vs. 8.5 ± 4.3 ×10⁹/L, P=0.005, respectively). Median CRP and procalcitonin levels were also significantly higher in severe pneumonia (101 vs. 39 mg/L and 1.43 vs. 0.35 ng/mL, respectively; P<0.001 for both). In multivariable analysis, hypoxemia was the strongest independent predictor of severe pneumonia (adjusted OR=7.82, 95% CI: 2.75–22.24; P<0.001), followed by tachypnea (OR=5.16, 95% CI: 1.42–18.71; P=0.013) and chest indrawing (OR=4.37, 95% CI: 1.61–11.88; P=0.004). CRP >60 mg/L and procalcitonin >0.5 ng/mL were also independently associated with severe disease. ROC analysis demonstrated that procalcitonin had the highest discriminatory ability (AUC=0.821), followed by CRP (AUC=0.789) and WBC count (AUC=0.681). Severe pneumonia was associated with higher rates of ICU admission, respiratory failure, sepsis, oxygen requirement, and prolonged hospitalization. Conclusions: Severe community-acquired pneumonia among hospitalized children was strongly associated with clinical indicators of respiratory compromise and elevated inflammatory biomarkers. Hypoxemia, tachypnea, and chest indrawing were important independent clinical predictors, while CRP and procalcitonin provided useful complementary laboratory information. An integrated assessment combining clinical examination, pulse oximetry, and selected inflammatory biomarkers may facilitate early identification of children at increased risk of severe CAP.